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Subject: Response via eform 100009 - VSP Application
Date: Wed, 11 Jan 2017 11:46:53 -0500
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<APP>WORKFLOW
<TEMPLATEID>350</TEMPLATEID>
<PREFIX></PREFIX>
<FIRST>Jill</FIRST>
<MIDDLE></MIDDLE>
<LAST>Julian</LAST>
<ADDR2></ADDR2>
<CITY>Easley</CITY>
<STATE>SC</STATE>
<ZIP>29640</ZIP>
<EMAIL>jjulian@g.clemson.edu</EMAIL>
<PHONE_B>8648551708</PHONE_B>
<ADDR1>430 Dacusville Hwy</ADDR1>
<TITLE>Assistant Executive Director</TITLE>
<ORGANIZATION>Mary's House</ORGANIZATION>
<WFUD_DateHire>01/02/2017</WFUD_DateHire>
<WFUD_County>Pickens</WFUD_County>
<WFUD_Muncipality>Pickens</WFUD_Muncipality>
<WFUD_JudCircuit>13th Cir</WFUD_JudCircuit>
<WFUD_Employment>Private/Non Profit Organization</WFUD_Employment>
<WFUD_Credentialing>Basic VSP</WFUD_Credentialing>
<ADDL_PEOPLE>
<PREFIX></PREFIX>
<FIRST>Kristina</FIRST>
<MIDDLE></MIDDLE>
<LAST>Smith</LAST>
<EMAIL>director@maryshouse.com</EMAIL>
<ORGANIZATION>Mary's House</ORGANIZATION>
<PHONE_B>8648551708</PHONE_B>
<TITLE>Executive Director</TITLE>
</ADDL_PEOPLE>
<SUBJECT></SUBJECT>
<CUSTOM1>96.37.73.69</CUSTOM1>
<MSG>

</MSG>

</APP>